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Despite the availability of evidence-based guidelines (e.g., Ann Intern Med 2007; 147:478) for conservative management of uncomplicated low back pain (LBP), many patients receive inappropriate imaging and treatments. Researchers used a U.S. national ambulatory care database to identify nearly 24,000 visits for spine problems from 1999 through 2010. Patients with “red flags” for complicated LBP — fever, weight loss, known cancer, or adverse neurological findings — or with a wide range of comorbid diagnoses were excluded.
Prescriptions for nonsteroidal anti-inflammatory drugs (NSAIDs) decreased from 1999 to 2010 (from 37% to 24% of patients), whereas prescriptions for narcotics increased (from 19% to 29%). Referrals to physical therapy remaine…